Eating Amidst Concerns: A Qualitative Study on the Experiences of Disordered Eating in Women with Gestational Diabetes Mellitus

Dandan Sun,1,* Xinyi Weng,2,* Jingjing Xu,3,4 Dan Luo2 1Department of Obstetrics, the First Affiliated Hospital with Nanjing Medical University, Nanjing, People’s Republic of China; 2School of Nursing, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China; 3Department of Nursing, the First Affiliated Hospital with Nanjing Medical University, Nanjing, People’s Republic of China; 4School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dan Luo, School of Nursing, Nanjing University of Chinese Medicine, No. 138 Xianlin Dadao, Qixia District, Nanjing City, Jiangsu Province, 210023, People’s Republic of China, Tel +8615720800662, Email [email protected]: Women with gestational diabetes mellitus (GDM) may experience disordered eating (DE), leading to adverse pregnancy outcomes and compromised mental health. However, in-depth studies in this field are lacking. This study explored the DE experiences among women with GDM, focusing on behavioral characteristics and potential risk factors.Patients and Methods: This study was a descriptive qualitative study. Using purposive sampling, 23 pregnant women with GDM who had exhibited DE behaviors within the past month were recruited from a maternal and child health hospital in Nanjing, China. Semi-structured interviews were conducted with the participants. Data were analyzed using conventional content analysis.Results: Three categories of DE experiences among women with GDM were identified: (1) behavioral characteristics; (2) internal drivers; (3) external enablers. DE behaviors in women with GDM primarily included restrictive eating, binge eating, and inappropriate insulin use. These behaviors often formed a vicious cycle: initial excessive restrictive eating led to binge eating due to intense hunger and food cravings, which in turn caused elevated glycemia and prompted impromptu restrictive eating, restarting the cycle. Inappropriate insulin use aimed at maintaining glycemic stability further perpetuated DE. Additionally, the study identified three internal drivers and three external enablers. Excessive risk perception mainly drove restrictive eating, insufficient internal motivation triggered binge eating, and low self-efficacy exacerbated both. Perceived pressure from dietary norms was a key external risk factor for the development of restrictive eating. Permissive messages from family members and disruptions from unexpected social events induced binge eating.Conclusion: Internal and external factors led to a restrictive-binge eating cycle in women with GDM, sustained by inappropriate insulin use. Excessive risk perception about hyperglycemia and fetal health existed as unique risk factors. Future studies should be conducted across diverse cultural and geographical contexts to enhance the generalizability of our findings.Keywords: pregnant women, perinatal mental health, dietary management, risk factors